Traveling NP

Since my Texas government gig didn’t work out, I needed to find an assignment to start ASAP. The only active licenses I had at the time were: Texas, California, and Florida.

For some reason, the Texas market for locum tenens positions had been dry all summer. I knew going back to California was not an option- as I promised myself I wouldn’t go back until at least next year. Lastly, Florida has a high density of Nurse Practitioners, so they do not have many traveling assignments available at any given time.

When I had thought the Texas assignment was a for sure thing, I slowly began applying for licenses in North Carolina and Virginia. I was in no rush because I thought I wouldn’t need to utilize either one of them until the following year. Lesson learned: always have new state licenses that you are working on.

Fortunately, the same day that I had turned down the Texas assignment, my Virginia license came in! During that same week, I had already had an interview with a site and accepted their offer!

They wanted me to start the following week, so everything happened pretty quickly, which I was grateful for. It wasn’t until I was on my way to Virginia that I realized Virginia requires a furnishing license to prescribed ALL medications, not just controlled substances like a few other states do.

I immediately freaked out thinking the site wouldn’t want me to start right away anymore. I was disappointed that no one from the agency noticed I was missing that licensing! Hello licensing and credentialing team! I was also upset at myself for forgetting to check the “Licensing” tab on my blog, which includes a chart of all required licenses per state. Of course the furnishing license requirement was on there, but I forgot to look!

After voicing my concerns to my recruiter, she informed me that the site still wanted me to proceed with my initial start date. Apparently the site does not allow any of their providers, including both physicians and nurse practitioners, to prescribe their own medications for the first 2-4 weeks. They have an onsite pharmacy in which providers dispense medications, so they only allow you to prescribe after formal training. In the mean time, any prescriptions I would need to order for my patients, would be placed by my supervising physician.

My family was surprised at how quickly I was leaving when I accepted the job, but it didn’t surprise me. My friends thought I was crazy when I was making my way up to Virginia without any official lodging details until the day of my arrival. To me, this was all a normal course of being a traveling Nurse Practitioner, where flexibility is always key!

A few months ago, I discussed some challenges I was facing applying for licenses in other states after already having a California license.

It turned out that one of the licenses I applied for (Virginia) – only required verification of my Nurse Practitioner license from the original state I was licensed in. This state happened to be Florida, which offered a quick turn-around.

On the other hand, one of the other licenses I applied for (North Carolina) – required I submit verification of my Nurse Practitioner license from ALL states I have ever been licensed in (both active and inactive).

After 3 months of my initial application with North Carolina, I have received my RN license, but the Nurse Practitioner license is still pending. Do you want to guess what is holding up my NP license? They still have not received verification of my California license. After paying $100 for the California verification, you have to wait another 2-3 months. At this rate, I doubt I will have the North Carolina license before winter hits

Some states, such as Washington, allow you to apply for your Nurse Practitioner license once you have a temporary RN license. However, North Carolina only allows you to apply for an NP license once you have a permanent RN license. So unfortunately, this causes a delay in the application process.

As a lesson learned, my recommendation to you other traveling Nurse Practitioners with a California license, is to give yourselves about 3 months to obtain new licensure. It always helps to do some research before applying for a new license to find out if they require verification of ALL of your licenses or just your first and/or most recent one.

As a traveling nurse practitioner, it’s difficult to plan out your vacations unless it’s truly last minute, because you have no idea where you will be later on in the year. I usually just plan my trips for the year and make my locum assignments work around them.

Before my next assignment, I had a planned trip to Europe with my family. We decided to go to London for the first time, since it finally peaked our interest after watching the show “The Tudors”. I had an amazing time in London; it definitely exceeded my expectations. There is just soooo much to do there!

We enjoyed going to Hampton Court Palace to see where Henry VIII once lived. We also loved the National Portrait Gallery because we were able to see all of the portraits of the Tudors and Stuarts and other royal families that we were used to seeing in books or online. I loved visiting Westminster Abbey, Shakespeare’s Globe, and the British Museum (where I got the see the Rosetta Stone!).

 

London was a lot more diverse than I expected. They had a lot of Arabs, Indians, Africans, and Eastern Europeans. At the same time it was very clean and people were nice and respectful. Using public transportation was straightforward. Fortunately for us, the pound went down after Brexit, so everything was pretty affordable. We enjoyed having afternoon tea in London as well.

We continued our trip to Ireland, hoping that being in the countryside would provide us with much needed rest and relaxation. Dublin was also pretty diverse – with plenty of immigrants from Eastern Europe. It was interesting to learn about Ireland’s history and how the English preferred to settle in America over Ireland, because there were constant uprisings and wars throughout Ireland.

 

We lucked out with some great weather in Ireland, as sunshine is pretty limited there. The picture above is us visiting St. Patrick’s Cathedral. The grass in Ireland was just as green as we imagined it to be. My favorite part was visiting the Cliffs of Moher (pictured below).

 

We ended the trip in France, since we like to go every year, as we have family that lives there. Paris is my favorite city in the world so I enjoyed promenading the Champs Elysees and eating macaroons any chance I got. We rode bikes around the Notre Dame and along the Seine River.

 

We wanted to visit a new section of France, so we agreed to go to Normandy. We took a day trip to Isle St. Michel, which is a magnificent church on top of an island. Sometimes the tide is high that you can only access the island via boat, other times you can take a trolley over the bridge.

 

After a fun 3 week trip to Europe, I returned home to start my next locum tenens adventure!

 

Although working as a locum tenens nurse practitioner is often like being in a dream, there are some aspects of having a permanent job that I miss.

• Long-term follow-up with my patients – one of the reasons I decided to work in primary care is to establish relationships with my patients and provide them with a personal experience. In locum tenens, I am able to follow-up with a handful of patients, but they are often being scheduled with their primary care providers, and only scheduled with me when there is no space with their PCP. In a 3-month assignment, there are a few patients that I am able to follow-up with every couple of weeks. Sometimes they ask me to become their PCP, but I do not have the heart to tell them I am leaving in 2 weeks.

 

• Stabilization – working in locum tenens you are always on the move. You are constantly thinking about where you are going next, how you are getting there, and how much time off you need in between. You are constantly learning new electronic health systems and adjusting to the flow of the clinic. Sometimes I miss just being able to settle down and not live in a whirlwind of surprises. Fortunately, if this was a huge issue for me I could opt for a long-term locums assignment.

 

• Peer relationships – the most difficult part of leaving each locum tenens assignment is saying bye to my co-workers. The people you work with are always an important part of your life because you spend so much time at your job. I miss having the same friends at work I can joke with and confide in. I have been lucky to make friends at each travel assignment, but I am always sad to leave them behind.

 

• Possessions – living out of several suitcases limits the amount of clothing and personal items I can bring with me on each assignment. Sometimes I miss just having all of my things with me for easy access. I find myself not enjoying shopping that much anymore because I worry about where I can fit my new stuff. At the same time, I like this lifestyle because it inhibits me from being a part of the consumerist society that Americans love. Now I am able to only buy things I absolutely need, vs want, and can set aside that extra money towards my savings or retirement plans.

 

While in Miami visiting with family and friends, I was fortunate to find a locum tenens position 5 minutes away from where I lived. This is a big deal considering locum tenens positions in Florida are quickly filled (who doesn’t want to live in sunshine by the beach?), and because Miami is a large city so you can easily commute to work up to 1.5 hours each way.

The position turned out to be in a Pediatrics Office. The Pediatricians that own the clinic were planning a vacation for them and their children. They needed a nurse practitioner to cover ‘walk-in’ patients. They said they used to be able to just close the clinic whenever they left town, but due to insurance payment changes, they had to stay open to prevent their patients from utilizing the Emergency Room.

I was to be the sole provider while providing coverage. I was content that I did not have to do any wellness child exams, but my only apprehension was having to do newborn exams (as they cannot predict when they would come).

The Pediatricians requested to meet me before I started the assignment. I was able to pass by one morning since their office was so close to home. They were reassured by meeting me because they said that the last time they had a locum tenens provider, he looked like he was ready to retire, and the patients complained that he kept zoning out while talking to them. I was also reassured by meeting them, because they seemed laid back and even provided me with a cheat sheet on common medications and doses used in pediatrics.

My first day I thought was such a relief from working with adults. The visits were very basic, I literally had 10 patients in a row with a chief complaint of earache and that’s all! Also, the children of course were adorable and so much fun to be around. The only challenging thing for me was calculating dosages. I have always been good at math and used to be the drug math tutor when I was a faculty member in a nursing college. Yet, I realized I was spoiled by places I worked at previously which had a range of weight and proper dosing of medication already listed for you in the EHR.

At this clinic, I had to do all the dosing by hand. The more I did it though, the more I found myself memorizing dosing by weight.

Another plus at this clinic was that they have someone that inputs all of the notes in the EHR. I merely write the chief complaint, check the positives for the review of systems and physical exam, write the diagnosis, and medications I prescribed on a one-page form. Then someone inputs my findings in a more detailed note into the EHR, including billing. This makes the process of seeing patients way faster.

On a slow day I only saw about 20 patients. On a busy day I saw 40 patients. Surprisingly, I never felt overwhelmed. I had a good time working with this site. The site also appreciated my help and requested that I cover a few days the following week when they go to a medical conference.

My locum tenens assignments ended right in time for a planned vacation to Puerto Rico. I was able to use miles on southwest airline that I earned from travel as a Nurse Practitioner. So my out of pocket cost for my flight was $11. I stayed at a beautiful Hilton resort on the beach. Since I am a Diamond elite member due to all of my stays in Hilton hotels as a traveling nurse practitioner, I was granted free continental breakfast and a room upgrade. These are some extra perks when working in locum tenens!

Puerto Rico was actually different than I imagined it to be. The forts throughout the coast were really interesting to explore and provided some historic flavor. Puerto Rico also has an expansive rain forest with outdoor activities. Of course I enjoyed swimming in refreshing water that was not ice cold (sorry California). The food was good too – my favorite being the ‘mofongo’, which is a dish made out of plantains. Only 2.5 hours from Miami, Puerto was a nice mini-getaway!